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 |