| NPI | 1114602570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER LYNN WARDLAW CEO/Licensed Professional Counselor 267-419-7846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2023-07-12 |