| NPI | 1477180388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA MORAN Owner 442-222-1108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2020-03-23 |