| NPI | 1689144537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER A MCCULLAH Account Rep Credentialing Manager 937-544-4020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2018-12-04 |