| NPI | 1386241933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIMAY LOIS MAXWELL Manager/Owner 754-213-1619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2023-04-03 |