| NPI | 1447532205 |
|---|---|
| Other Name | AZAELA TRACE ASSISTED LIVING |
| Entity Type | Organization |
| Authorized Contact | THELMA DEES-JOHNSON Lpc Mhsp 6159-150-4074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN 2111) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 2111) |
| 104100000X Social Worker (Licence: TN 3847) | |
| 106H00000X Marriage & Family Therapist (Licence: TN 2111) | |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2013-06-04 |