| NPI | 1295215325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAMEKA GREGORY Owner 617-917-4149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: MA 120804) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: MA 120804) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2018-08-17 |