| NPI | 1790477099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY LEE WEAVER Clinician 586-318-4221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2023-12-15 |