| NPI | 1124887005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBEKAH LEWIS Ap RN 531-201-6092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-03-14 |
| Last Update Date | 2024-03-14 |