| NPI | 1811253719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN HARRELL JANSEN Owner 229-244-5533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA 4280) |
| Additional Taxonomies | 251S00000X (Licence: GA 4567) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2012-04-04 |