| NPI | 1710501556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FANNIE BEATRICE WALLACE Mental Health Therapist 501-553-5539 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2020-06-06 |
| Last Update Date | 2020-06-06 |