| NPI | 1811417587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUEENIE V LATHAN Clinical Counselor 330-219-5892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E0700418SUPV) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2022-07-21 |