| NPI | 1992290522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLIE SWINDOL WEST Owner/Clinician 601-606-0561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MS 2114) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: MS 2114) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2022-11-02 |