NPI | 1700484755 |
---|---|
Entity Type | Organization |
Authorized Contact | ALEXANDER SULLIVAN Credentialing Specialist 269-547-9730 |
Organization Subpart ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2020-10-13 |
Last Update Date | 2020-10-13 |