| NPI | 1841918695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZYESHIA JENKINS Provider 315-838-4006 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2022-08-18 |