| NPI | 1588748982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARME S. S. DAVIDSON Sole Owner/Sole Member 612-870-0510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP2642) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2021-07-07 |