| NPI | 1235000589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REUBEN G JACKSON Owner 704-606-4245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-09-17 |
| Last Update Date | 2025-09-17 |