| NPI | 1639808025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM MCKETHER Owner 810-584-5679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2022-06-09 |