| NPI | 1427480060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDDIE R. WILSON Administrator 270-904-1072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 3505) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2024-01-02 |