| NPI | 1639524069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVONTE DICKERSON MOTTLEY Counseling 832-506-8121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2016-05-04 |