| NPI | 1578909362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORI ANNE DYSON Owner 870-972-1497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: AR E-5305) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2013-05-23 |