| NPI | 1427862804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PERSIDA GHIBILIC Lpc 267-312-2231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-02-13 |