| NPI | 1235829722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA NICOLE STREET CEO 276-734-3421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 251S00000X Community/Behavioral Health | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2026-02-27 |