| NPI | 1518925676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA M DORNON Credentialing Specialist 740-368-7834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2012-08-15 |