| NPI | 1639835689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUNNIKA GREEN Therapist 346-429-7886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251S00000X | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2021-11-15 |