| NPI | 1891722146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON M THAYER Administrator 606-679-6995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2017-02-06 |