| NPI | 1619599875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUANN J. BOULIO-LUCIER Member 912-272-4861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2020-05-11 |