| NPI | 1124568613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIME KATHRYN PARKER Owner 228-217-0119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS 1479) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2017-03-02 |