| NPI | 1023906773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PORTIA VAN SANT Director 267-225-3936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2025-08-12 |