| NPI | 1609370261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA MARY ERICKSON Plmhp 229-506-2708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NE 11080) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2023-04-12 |