| NPI | 1487090841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMARKUS PHANELSON Owner 276-618-0759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2013-05-13 |