| NPI | 1568314094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRAN DEWALT Licensed Clinical Social Worker 502-644-1372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2026-02-09 |
| Last Update Date | 2026-02-09 |