| NPI | 1376162040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY WILLIAMS Credentialing Specialist 202-715-7900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2020-04-28 |