| NPI | 1285019927 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANE GOULD-HARTLINE Provider/Owner 205-968-1227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: AL 1048511) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2018-03-15 |