| NPI | 1275085706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE VANESSA VAUGHN-JACKSON Owner 334-201-5052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6801089011) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2016-11-01 |