| NPI | 1962240259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH COLE-RANDALL Credentialing Specialist 774-454-4635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-07-19 |
| Last Update Date | 2024-07-22 |