| NPI | 1194173005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMETRICE MARIE CLARK Administrator 225-253-1277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2023-11-02 |