| NPI | 1760202741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLY JANE HERBERT Owner 951-269-9617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-10-14 |
| Last Update Date | 2024-10-14 |