| NPI | 1720101082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTY WISE Director 877-880-7337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC1900X Psychologist, Counseling | |
| 103TE1100X Psychologist, Exercise & Sports | |
| 103TF0000X Psychologist, Family | |
| 103TF0200X Psychologist, Forensic | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2012-01-17 |