| NPI | 1922513738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVY DESIRAE BENNETT SIAS Owner 310-429-5025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor | |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2017-12-04 |