| NPI | 1386386977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DWAYNE WILLIS Project Director 310-920-2068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2022-04-13 |