| NPI | 1578146288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA LYNN FREEMAN Credentialing Manager 501-368-0132 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2021-04-30 |