| NPI | 1487851978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE CHRISTINE WILCOX Single Owner LLC 385-235-6926 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 270969-3501) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 270969-6006) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2018-11-06 |