| NPI | 1356804694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIENNE LEWIS BLEAKLEY Licensed Profession Counselor 318-613-6912 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2019-04-12 |