| NPI | 1316464951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA MARIA KELLEY-FREEMAN CEO 800-867-2395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD BH000195) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 251S00000X | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MD BH000195) | |
| 261QM1300X Clinic/Center, Multi-Specialty (Licence: MD BH00095) | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2018-05-25 |