| NPI | 1366215113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN DENICE THOMPSON Nurse Practitioner/ Administrator 346-399-9241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2023-11-02 |