| NPI | 1497558381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDISON MBEMNGONG Owner 502-303-0921 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-03-28 |
| Last Update Date | 2025-03-28 |