| NPI | 1508730045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAILAN JOHNSON CEO, Owner 980-349-0414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QA0600X Clinic/Center, Adult Day Care | |
| Enumeration Date | 2025-09-29 |
| Last Update Date | 2025-09-30 |