| NPI | 1962623249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKEY L WILSON President 574-233-5858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IN 50003038A) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |