| NPI | 1386368850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANQUINARTA LEE Owner 910-301-7752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2022-09-28 |