| NPI | 1992208623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAJUANA E MITCHELL Lpc 313-590-5253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: AZ LPC16755) | |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2021-03-30 |