| NPI | 1215766894 |
|---|---|
| Former Legal Business Name | COFFEE TALK THERAPY, PLLC |
| Entity Type | Organization |
| Authorized Contact | JACKLYN MICHELE BLAKE Executive Director 984-689-1714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-07-31 |
| Last Update Date | 2024-09-20 |