| NPI | 1982058533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA VYVERBERG Owner 228-331-3310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS R889555) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |