| NPI | 1386250694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASMINE THOMAS Owner 810-214-0512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2020-09-22 |