| NPI | 1194425413 |
|---|---|
| Doing Business As | 180 TLC |
| Entity Type | Organization |
| Authorized Contact | SHUKAIRO MACK BAKER Clinical Director 980-309-8508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-03-06 |
| Last Update Date | 2023-03-06 |