| NPI | 1912624495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI RENEE KLUBNIK Owner/Director 228-669-4367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2023-02-13 |