| NPI | 1275377129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA TUCKER Systems Specialist 567-416-9997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-12-03 |