| NPI | 1366906943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASIA HENDERSON Owner 401-808-6421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2021-09-09 |