| NPI | 1144757048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILLIESHA GRANDBERRY Counselor 469-396-6719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2017-05-23 |