|Taxonomy Code||Specialty Code||Provider Type|
|1041C0700X||80||Licensed Clinical Social Worker|
|LBN Legal business name||DIGNITY LIVING CLINICS OF NORTH AMERICA|
|DBA Doing business as||DIGNITY LIVING CLINICS|
|Authorized official||JULIE HENDERSHOTT - (CLINICAL DIRECTOR)|
|Organization subpart 1||No|
|Last updated||06/02/2016 - About 5 months ago|
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