| NPI | 1700155595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY DEWAYNE PETTIFORD CEO 618-274-3850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP1600X Counselor, Pastoral | |
| 101YP2500X Counselor, Professional | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2011-12-22 |