| NPI | 1902681331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE SHAMOON Credentialing Director 888-341-4449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional | |
| 103TC0700X Psychologist Clinical | |
| 104100000X Social Worker | |
| 171M00000X Case Manager/Care Coordinator | |
| 3747P1801X Technician Personal Care Attendant | |
| 251X00000X Supports Brokerage | |
| 3747A0650X Technician Attendant Care Provider | |
| 376J00000X Homemaker | |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2023-08-24 |