| NPI | 1861165573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY LYNN SKOWRONSKI Licensed Clinical Social Worker 872-216-1763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2021-07-28 |