| NPI | 1275281487 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE BLACK DOS SANTOS Clinician/Owner 857-208-0093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2022-03-16 |