| NPI | 1649357161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUDI L JACKSON President 8043-378-7710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 829) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 829) |
| 101YM0800X Counselor, Mental Health (Licence: VA 829-03-001) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2011-04-13 |