| NPI | 1649843228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDREY SOUTH Owner 385-220-4751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2021-07-21 |