| NPI | 1689939951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNARD SULLIVAN Owner 877-306-3748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TA0700X Psychologist Adult Development & Aging | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2012-07-11 |