| NPI | 1114632577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA CONN Member 606-775-0515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-01-20 |
| Last Update Date | 2023-01-20 |