| NPI | 1467707331 |
|---|---|
| Other Name | AB 109-SM |
| Entity Type | Organization |
| Authorized Contact | TAMMY CASIANO Qcm Coordinator/Designee 805-325-5905 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2021-08-23 |