| NPI | 1477930469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN EDWARD HAIRSTON CEO/Director 276-403-4740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-04-29 |