| NPI | 1063982114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN ELIZABETH TINSLEY Managing Member 302-674-1397 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-12-03 |
| Last Update Date | 2018-12-03 |