| NPI | 1376010918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY KATHLEEN GIBBONS Owner 618-406-8857 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2018-11-01 |