| NPI | 1891319950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FANNIE BEATRICE WALLACE, MS Mental Health Therapist 501-553-5539 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2020-06-04 |