| NPI | 1578115564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY M AVERETTE-SMITH Sole Proprietor 330-313-5773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261QM0801X | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2019-07-10 |