| NPI | 1225809635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEEYANNA CROCKETT Owner 614-507-5908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2024-12-04 |