| NPI | 1639862089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA NICOLE WINDHAM Pmhnp Bc 143-235-2976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2023-05-31 |