| NPI | 1851880264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIAN DELANE CLARK CEO 228-861-0148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 13329) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2018-05-29 |