| NPI | 1659028918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUINCY STOCKTON Office Manager 315-559-7961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2022-03-07 |
| Last Update Date | 2022-03-07 |