| NPI | 1568226215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN ANTON Owner 678-203-4612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-02-21 |