| NPI | 1477003119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELINDA GEREMILLO DRAKE Director 424-781-7306 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 106H00000X Marriage & Family Therapist | |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2021-01-06 |