| NPI | 1972378313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARNE FUQUA Owner/Operator 800-554-2503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2023-12-26 |