| NPI | 1083073217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMIQUE MICHELLE JOHNSON Mental Health Professional 318-780-2828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: LA 19320000X/101YM0800X) |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2016-02-16 |