| NPI | 1952841041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE DAVIS Mental Health Counselor 267-235-7138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: PA 724086) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2017-03-08 |