| NPI | 1255720694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMARKUS PHANELSON CEO 276-618-0759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 103G00000X Clinical Neuropsychologist | |
| 103TC0700X Psychologist, Clinical | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2015-01-22 |