| NPI | 1205592516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER FUDGE Owner, Provider 458-331-0531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-11-10 |
| Last Update Date | 2025-08-19 |