| NPI | 1164895793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACK REESE Licensed Counselor 901-337-5421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 305S00000X Point of Service (Licence: MA 000539106) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2015-11-04 |