| NPI | 1366028540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAITLIN BURDETTE Owner 571-419-2892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251C00000X |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2023-11-20 |