| NPI | 1518227453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EQUITS BOND Credentialing 614-340-6717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2022-10-26 |