| NPI | 1629381728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY R STOCK Licensed Clinical Social Worker 228-216-0130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C2936) |
| Enumeration Date | 2010-07-17 |
| Last Update Date | 2010-07-17 |