| NPI | 1598363673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAYRUS ABDIRAHMAN DUALE President 614-805-1982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2022-09-14 |