| NPI | 1518396548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEFANIE JACKSON CFO 229-671-6140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2013-11-18 |