| NPI | 1750878781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOCELYN GAVIN-LANE Owner 228-220-4226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C6462) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2018-04-16 |