| NPI | 1942862552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELSTON DERREK HOOPER Owner 980-297-0703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service |
| 302F00000X Exclusive Provider Organization | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2019-07-03 |