| NPI | 1023982873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SPONTANEOUS OTHEA THOMAS Owner 980-309-5466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-10-03 |
| Last Update Date | 2025-10-08 |