| NPI | 1568861037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDRIA KAYE BLACK Physician 901-755-6280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: TN 36627) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: TN 36627) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2014-08-20 |