| NPI | 1639841893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL SIMMONS Owner 704-430-1038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2022-01-11 |