| NPI | 1164287546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER JACK KILBANE Owner/Manager 304-238-4074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2024-02-15 |
| Last Update Date | 2024-03-20 |