| NPI | 1891435657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA ANN KIMBLE Owner/Lcsw 618-218-4544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-04-18 |