| NPI | 1164962908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA DENISE HURST Owner 678-600-3717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NV NV20171142637) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2018-01-08 |