| NPI | 1457835878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANEQUIA NICKI CLEMONS Rehab Practitioner 210-606-2319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 175T00000X Peer Specialist | |
| 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry | |
| 2084F0202X Psychiatry & Neurology Forensic Psychiatry | |
| 2084P0005X Psychiatry & Neurology Neurodevelopmental Disabilities | |
| 261QC1500X Clinic/Center Community Health | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QR0401X Clinic/Center Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 385HR2055X Respite Care Respite Care, Mental Illness, Child | |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2018-12-21 |