| NPI | 1235593229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA THOMPSON Licensing & Credentialing Specialis 844-291-4535 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2016-04-06 |