| NPI | 1306572235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MADISON MICHELLE ASHBY Administrative Assistant 662-871-6657 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2022-07-25 |