| NPI | 1619213055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWIGHT RANDOLPH COLEMAN Mental Health Associate 505-710-1826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2012-12-12 |