| NPI | 1912548991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY LOUNSBURY Operations Director 386-454-0660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 101YP1600X Counselor Pastoral | |
| 101YS0200X Counselor School | |
| 106S00000X Behavior Technician | |
| 251B00000X Case Management | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2023-01-28 |