| NPI | 1538634654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK WOODBURY Owner 479-283-1016 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2019-10-14 |