| NPI | 1851514277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEFAN MASSONG Practice Manager 228-861-0167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |