| NPI | 1033944731 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUINCY ALAN JOHNSON Employee 330-503-8802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2024-09-04 |
| Last Update Date | 2024-09-04 |