| NPI | 1124550587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AGUSTIN J CRUZ Chief Executive Officer 229-412-8125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006356) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701006356) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0701006356) | |
| 101YM0800X Counselor, Mental Health (Licence: VA 0701006356) | |
| 102L00000X Psychoanalyst (Licence: VA 0701006356) | |
| 103K00000X Behavior Analyst (Licence: VA 0701006356) | |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717001358) | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2017-04-03 |