| NPI | 1023829819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON PAUL WAGGONER Owner 304-444-7315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2025-01-20 |
| Last Update Date | 2025-01-28 |