| NPI | 1164124012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKESHA WELCH Chief Operating Officer 980-579-9415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251B00000X Case Management |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2023-03-21 |