| NPI | 1922994334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVEN SAMA BRODEN Owner 980-777-3980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2025-07-30 |