| NPI | 1528650678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKITTA JOHNSON Owner/Provider 769-208-3642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2021-03-13 |