| NPI | 1730711094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE LEIGH NICHOLS Clinical Director 267-209-0449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2021-05-05 |