| NPI | 1104692193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL STIDUM Owner/Licensed Therapist 501-412-0069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2024-01-05 |