| NPI | 1528582590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NONA LEIGH WILSON Owner 224-204-7966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 180009914) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2023-11-07 |