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 |