| NPI | 1255172631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN KALEL BAKSH CEO 772-617-6373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2024-06-01 |
| Last Update Date | 2024-06-01 |