| NPI | 1003555079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RIVA CORNELIUS Owner 228-493-9141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-05-30 |
| Last Update Date | 2023-01-21 |