| NPI | 1316650062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISHEMA BOLEY Lpc 318-805-2992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2022-12-27 |
| Last Update Date | 2023-03-28 |