| NPI | 1639764541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAYRENE VICTORIANO Consultant 725-400-1888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2021-03-02 |