| NPI | 1487361796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONQUIL CROWOLL-FONSECA Owner 754-218-7582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2024-08-05 |