| NPI | 1265181572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY STRATTON Owner 386-965-6901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2024-02-15 |