| NPI | 1043903875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON FOUNTAIN President 808-306-3054 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2025-05-13 |