| NPI | 1841634359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY R STOCK Licensed Clinical Social Worker 228-216-0130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 3058) |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2013-04-26 |