| NPI | 1124531041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACH FRANCIS THOMPSON Therapist 251-725-4332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: AL 3197) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2017-11-14 |