| NPI | 1609620012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHONTEL A JOHNSON MCCALLUM CEO 754-400-0285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-04-12 |
| Last Update Date | 2024-04-12 |