| NPI | 1093366775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN KIM WAGGONER CEO 228-819-2171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist, Clinical | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2022-08-08 |