| NPI | 1265823355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETHANY F MIRACLE-LARSON Resident In Counseling 571-422-0056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2015-02-11 |