| NPI | 1790204204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN B LEWIS Licensed Professional Counselor 484-459-6813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA LPC007441) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: GA LPC007441) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: GA LPC007441) | |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2017-09-15 |