| NPI | 1093453540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ANNE DAVIS Owner 986-213-6628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2026-08-10 |