| NPI | 1053121509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN D FERGUSON Owner 606-791-7928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2025-01-08 |
| Last Update Date | 2025-01-08 |