| NPI | 1083185748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVIN ANTHONY LOCKETT President 424-204-2382 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center Adult Mental Health | |
| Enumeration Date | 2018-12-06 |
| Last Update Date | 2019-04-27 |