| NPI | 1124256789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER M JACKSON Clinical Psychologist 251-599-3728 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2009-06-22 |