| NPI | 1609467240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA ALEXANDER JACKSON Owner 910-476-0322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2021-01-27 |