| NPI | 1922600055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA KIM CLEVELAND Owner 229-483-5050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2021-02-04 |