| NPI | 1871180752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KESHA JACKSON Social Worker/Mh Clinician 419-807-8185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2020-12-28 |
| Last Update Date | 2021-04-12 |