| NPI | 1174466999 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENI CHURCH-HINES Clinical Director 984-385-2650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 251S00000X Community/Behavioral Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2026-04-14 |
| Last Update Date | 2026-08-04 |