| NPI | 1891130522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA ANN WILSON Clinical Social Worker 928-737-6188 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 0698081) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2013-05-08 |