| NPI | 1780001990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE C RENZ Practice Manager 339-364-8080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 114402) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2026-04-06 |