| NPI | 1194405662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALTRENEASHA ERVIN Owner 679-789-9237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2023-07-20 |