| NPI | 1053804617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI JO AILEY-ROBERSON Owner 515-508-1150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IA 00918) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2021-10-19 |