| NPI | 1760061535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN K SKINNER Owner 501-800-7316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-10-29 |