| NPI | 1750073821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORNA RUTHERFORD Provider/Owner 606-425-0251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2023-05-25 |