| NPI | 1902554629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MORGAN ANN FULTON-GORHAM Licensed Clinical Social Worker 309-219-5384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2022-05-19 |