| NPI | 1548600737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSSA VAIL Administration 662-840-4577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2013-07-02 |