| NPI | 1083722367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA HOLLOWAY Administrative Manager 502-452-6341 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2022-01-25 |