| NPI | 1922578855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK GREEN Owner 857-598-2808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker | |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2020-03-03 |