| NPI | 1407030463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ASHLEY CASSITY SIMPSON Program Director/Therapist 251-626-5797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL C1058A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AL 150MLAP) |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2007-12-26 |