| NPI | 1124824974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRELLE W DICKERSON Chief Operations Officer 144-449-0409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-04-07 |