| NPI | 1962193235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THADDEUS JAMAL TOLBERT Member And Owner 346-298-1879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2024-03-11 |