| NPI | 1548749666 |
|---|---|
| Doing Business As | PROVIDENCE PLACE |
| Entity Type | Organization |
| Authorized Contact | ANGELICA NANEZ CERVANTES Chief Program Officer 210-696-2410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2018-08-09 |