| NPI | 1265264857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARITY JACKSON Owner 940-220-1684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2024-08-14 |