| NPI | 1003646977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA ROACH Chief Administrative Cred Officer 844-843-7279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103T00000X Psychologist | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2024-11-22 |