| NPI | 1407714405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMAL VANCE Owner 833-203-1300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TH0100X Psychologist, Health Service | |
| 103TC1900X Psychologist, Counseling | |
| 101YM0800X Counselor, Mental Health | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2026-01-10 |
| Last Update Date | 2026-01-12 |