| NPI | 1538608534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE CROCKER Partial Owner 848-999-4244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2021-03-17 |