| NPI | 1184262354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LYN MAGERS Business Manager 386-314-7207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2019-12-19 |