| NPI | 1699051219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY SUTHERLAND Therapist 502-741-6065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 6985612-3501) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2011-10-26 |