| NPI | 1073282778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORNELIA JOHNSON Owner 346-235-3926 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional | |
| 1041C0700X Social Worker, Clinical | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2024-01-20 |