NPI | 1144092289 |
---|---|
Entity Type | Organization |
Authorized Contact | THEODORE WILDER Lcpc/Director 779-707-0597 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2023-10-23 |
Last Update Date | 2023-10-23 |