| NPI | 1144738188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL HARRISON Owner 772-480-5611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2018-01-11 |