| NPI | 1649011818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINA TUCKER Consultant/Authorized Agent 567-416-9997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2024-06-03 |