| NPI | 1952170060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKETRIA VENZANT CEO 877-396-3330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| 106H00000X Marriage & Family Therapist | |
| 251S00000X Community/Behavioral Health | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2023-12-29 |
| Last Update Date | 2023-12-29 |