| NPI | 1205412400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLA WHITE President, Provider 508-422-0024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2021-03-19 |