| NPI | 1992268627 |
|---|---|
| Other Name | N/A |
| Entity Type | Organization |
| Authorized Contact | DEANNA OMONIYI Licensed Clinical Social Worker 269-598-2837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2022-05-02 |