| NPI | 1154015253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAMAR FAGGART Owner 980-365-0100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2023-06-05 |