| NPI | 1861194623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA ELLIS Lpc 346-509-1013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor | |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2025-10-14 |