| NPI | 1164038782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER TIDWELL Owner 201-906-1025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2020-09-18 |