| NPI | 1902591514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FELECIA DAVIS MODICUE Lpc, CEO 318-680-8414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2023-04-10 |