| NPI | 1316181365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERRILLE S JONES Executive Assistance 662-510-5264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: TPR-BADA-SAPT- 01) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: TPR-BADA-APH-01) | |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2014-06-06 |