| NPI | 1083071385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENOSHIA R JACKSON Owner 800-317-0364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2016-08-30 |