| NPI | 1033954557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES HENRY MACEDONE Owner, Clinical Director 385-201-7236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-06-26 |
| Last Update Date | 2024-06-26 |