| NPI | 1710107438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRAD LEO FLICK Director 228-435-2673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MS 26352) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MS C0914) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-08-22 |