| NPI | 1457244295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY SHANDREKA PETERSON Np 725-712-4625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2025-10-24 |