| NPI | 1518804194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J ANSLEY Owner 772-321-9180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2026-05-01 |
| Last Update Date | 2026-05-04 |