| NPI | 1619285269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES E. DAVIS President And Registered Agent 708-431-2245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071003271) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2010-09-16 |