| NPI | 1063798106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CELESTE MARIE BALLARD Owner 865-985-1084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL LCPC 180007509) |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2021-11-15 |