| NPI | 1053709360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELITA WALLINGFORD Director 360-703-1192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA 603376586) |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2015-01-08 |