| NPI | 1265632590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE ANN ODOM President Shared Services 947-522-3326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MI 6801080343) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2021-10-21 |