| NPI | 1013660620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA WADDELL Owner 907-250-6608 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2022-02-02 |