| NPI | 1013499565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANA K DAVIS CEO 618-315-9464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2018-08-31 |
| Last Update Date | 2019-08-14 |