| NPI | 1922344621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA MICHELLE PHILLIPS Business Manager 318-617-5869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: LA 10334080#B4P83) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2017-12-02 |