| NPI | 1063662229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WALLACE LUDGATE President 276-628-5752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0810002165) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2008-09-24 |