| NPI | 1750813341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE LEE CHEVERALLS Owner 617-875-2982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 10813) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-3559) |
| 101YM0800X Counselor, Mental Health (Licence: NC A10862) | |
| 101YM0800X Counselor, Mental Health (Licence: NC A12714) | |
| 101YM0800X Counselor, Mental Health (Licence: NC 10507) | |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2017-04-01 |