| NPI | 1235709775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NECOLE JOHNSON Office Manager 855-664-0772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent |
| 251B00000X Case Management | |
| 251S00000X | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2021-06-29 |