| NPI | 1700037124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNIE LYERLY Provider Credentialing 870-972-4939 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2012-12-12 |