NPI | 1194173005 |
---|---|
Entity Type | Organization |
Authorized Contact | DEMETRICE MARIE CLARK Administrator 225-253-1277 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
251S00000X | |
Enumeration Date | 2016-06-01 |
Last Update Date | 2023-11-02 |