| NPI | 1497588974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRICIA NORTHINGTON Owner 315-727-0206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-08-21 |
| Last Update Date | 2025-08-28 |