| NPI | 1508608654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER NICOLE ANTOINNETTE DISE Nurse Practitioner 571-398-9278 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2024-06-10 |