| NPI | 1487065587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICARDO FRAGA Owner 601-693-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS mclpc1329) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2014-05-13 |