| NPI | 1578929626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH CARSWELL CEO 870-718-6007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: FL IMH 13452) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 101YP1600X Counselor, Pastoral | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2016-01-05 |