| NPI | 1932908357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSALIND WILLIS Provider Enrollment Specialist 440-850-5235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2025-03-10 |
| Last Update Date | 2025-03-10 |