| NPI | 1043748981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE SMITH-TINGLE Owner Administrator 571-264-8383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2017-05-23 |