| NPI | 1295283000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARME THOMPSON Owner 318-219-6112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2023-06-27 |