| NPI | 1891090783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RITA IRENE POLIVICK Owner 260-437-1248 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 34003316A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH4219) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2011-01-24 |