| NPI | 1053944090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JOHNSON Member 740-804-1526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-02-18 |