| NPI | 1780481945 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | CLAYTON BLACK Owner 740-243-5542 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) | 
| Enumeration Date | 2025-02-26 | 
| Last Update Date | 2025-02-26 |