| NPI | 1023520764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA M KELLEY-FREEMAN CEO 800-867-2395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LCA2304) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LCA2304) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD BH000384) | |
| 101YS0200X Counselor, School (Licence: LCA2304) | |
| 251S00000X Community/Behavioral Health | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2018-05-04 |