| NPI | 1750802534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS L DICKERSON Owner 228-331-3310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C5893) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2022-07-21 |