| NPI | 1972633964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA KING Director, Credentialing Enrollment 800-370-3651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2017-07-11 |