| NPI | 1619367901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NYKOL R WAHLBERG Owner 719-271-6306 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 00002014) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2024-04-23 |