| NPI | 1578937199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATTRINA MILLER ROACH Owner 662-404-1134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MS 2041) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2015-11-19 |