| NPI | 1639789019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA VACCARELLA President 218-302-4678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2021-02-01 |