| NPI | 1053818641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHATERRICA NASHAE ISAAC Owner 318-716-1841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA BH0012334) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2018-04-10 |