| NPI | 1124744917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ACACIA LYNETTE JOHNSON Therapist 501-278-6688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QR1100X Clinic/Center, Research | |
| 261QR1300X Clinic/Center, Rural Health | |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2022-10-13 |