| NPI | 1932762754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONARDO PATRICK GLOVER CEO 870-718-6199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2019-04-17 |