| NPI | 1114633773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA JEAN PHARES Owner 304-400-4068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2024-05-09 |