| NPI | 1639669864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKEISHA MONIQUE WOODS Owner 262-995-0722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8711-123) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2019-02-25 |