| NPI | 1013379676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICARDO HICKS Owner 571-247-4011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2016-03-23 |