| NPI | 1801994199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE JESSE CARLOCK Owner /Psychologist 937-256-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2009-10-13 |