| NPI | 1003500562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBDREKA SHAW Licensed Professional Counselor 662-822-5811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2023-06-07 |