| NPI | 1780922393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN J LOVELACE Accounts Manager 731-445-0089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TN LSW0000005633) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TN LSW0000005633) |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2015-03-17 |