| NPI | 1609635895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMELLIA DOUGLAS Owner/Provider 877-306-1683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2026-06-03 |