| NPI | 1063064681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY ANNE WINGATE Treasurer & CFO 844-422-3632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-07-13 |
| Last Update Date | 2019-07-13 |