| NPI | 1508472648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELSEY LAINE BACKES President 251-209-0216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2020-12-07 |