| NPI | 1003709833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PARIS LINDSEY-WADE Owner 220-219-6059 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2025-05-30 |