| NPI | 1053269365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARQUITA LATISHA DAVIS Owner 943-888-7617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2026-03-20 |
| Last Update Date | 2026-03-20 |