| NPI | 1174182992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESSA CRAWFORD Owner 502-512-2895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2022-01-22 |