| NPI | 1629816269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA JO BANKSTON Owner 479-970-6454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-07-17 |