| NPI | 1588480511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY POWELL Manager 571-306-2543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-11-25 |
| Last Update Date | 2024-11-25 |