| NPI | 1154914513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA KONADU-FORD Therapist 980-494-0383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2022-10-12 |