| NPI | 1255916227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE WAGNER Owner/Member 980-272-8561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2021-03-11 |