| NPI | 1730636523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA RAYMOND LARSON Licensed Social Worker 734-635-9365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801046960) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2016-09-08 |