| NPI | 1780345900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN VICTORY Authorized Official 855-227-3574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2025-01-17 |