| NPI | 1497319842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN HUERKAMP Outpatient Counselor 601-506-2122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2019-04-30 |