| NPI | 1649732710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAIDEMBER GUEMEZ Manager 786-800-4759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2021-06-18 |