| NPI | 1770310799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH MOUSSEAU MALDONADO Owner 218-996-2144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2024-09-14 |
| Last Update Date | 2024-09-14 |