| NPI | 1184677619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN BIRTH Chief Executive Officer 618-398-1152 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 165005001) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 101YM0800X) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2007-07-26 |