| NPI | 1568353597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY NICOLE MALCOM-BUTLER Owner 870-210-0230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2025-07-09 |
| Last Update Date | 2025-08-05 |