| NPI | 1588357768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY ELIZABETH BACON-LATINA Therapist; Owner 501-802-0107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2023-06-01 |