| NPI | 1679285043 |
|---|---|
| Doing Business As | SOUTHPARK PSYCHOTHERAPY |
| Entity Type | Organization |
| Authorized Contact | SARA ELIZABETH WILKERSON Counselor And Owner 980-999-0501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2024-11-10 |