| NPI | 1679823777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINIQUE LASHANDA JAMISON-WILLIAMS Owner 219-805-3355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: IN 31002428A) |
| Enumeration Date | 2012-09-16 |
| Last Update Date | 2012-09-16 |