| NPI | 1285294439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA HERBIN Owner 980-875-8761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2019-06-19 |