| NPI | 1003512674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAIGE FLORA Therapist 270-202-1096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2025-03-26 |