| NPI | 1740992072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHERINE O'CONNOR Owner 772-888-2830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2022-12-19 |