| NPI | 1033454772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA JOHNSON Executive Director 016-259-5745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MS M7862) |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2021-03-22 |