| NPI | 1205359528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AISHA R MITCHELL WASHINGTON Owner 334-782-2743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2022-07-21 |