| NPI | 1912579202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE LEWIS Clinical Director 228-231-0516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2021-07-15 |