| NPI | 1487214052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL MICKEN Owner/Operator 229-726-4714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-06-17 |