| NPI | 1194561647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTRICE HURST Owner 225-900-7075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-07-03 |
| Last Update Date | 2024-07-03 |