| NPI | 1508616046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANIEKA ANNALIECIA GENTLES Owner 774-242-0312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2024-03-26 |