| NPI | 1629738075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARRA CAMPBELL Owner 855-207-6937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2021-12-27 |
| Last Update Date | 2021-12-27 |