| NPI | 1649316787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY JONES Hippa Officer 791-457-0660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 3127) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-08-22 |