| NPI | 1508456047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE MAYO Owner 469-510-4291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 171M00000X Case Manager/Care Coordinator | |
| 251B00000X Case Management | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2024-08-22 |