| NPI | 1982199683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESIREE COLONICA Owner/Operator 541-224-1684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7404) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2018-06-25 |