| NPI | 1356838569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES ADOLPH WEINER Vice President/COO 870-230-8217 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2018-04-13 |