| NPI | 1891110060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LONNIE MULLET Director 980-430-4972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2019-05-01 |