| NPI | 1063179059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NOURA EBRAHIM Clinical Director 733-724-0665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-11-24 |
| Last Update Date | 2021-11-24 |