| NPI | 1205195807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA C YOUNGBLOOD Owner/Director 719-459-6710 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 1575) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 4082) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2012-05-16 |