| NPI | 1649817347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY CARROLL Director 866-203-0308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2019-12-02 |