| NPI | 1124329388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY TODD KINDER Licensed Professional Counselor 276-963-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2025-11-05 |