| NPI | 1508103987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAN EDWARD NICHOLS Owner 903-268-2796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 534626) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 2359) |
| Enumeration Date | 2013-01-06 |
| Last Update Date | 2013-01-06 |