| NPI | 1568928877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDITH ANN BLACK President 681-404-6869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TF0000X Psychologist Family |
| 103TS0200X Psychologist School | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 101YM0800X Counselor Mental Health | |
| 101YP1600X Counselor Pastoral | |
| 101YP2500X Counselor Professional | |
| 103TC0700X Psychologist Clinical | |
| 103TC1900X Psychologist Counseling | |
| 101Y00000X Counselor | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2024-01-17 |