| NPI | 1821501933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE DIEVENDORF WEISS Owner 269-520-0050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401011020) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301013930) |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2020-05-03 |