| NPI | 1205651627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAKENA ST Owner 984-313-2526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2024-11-20 |
| Last Update Date | 2025-01-26 |