| NPI | 1124731476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON GHOLSON Intake Coordinator 857-939-4445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-01-03 |
| Last Update Date | 2023-01-26 |