| NPI | 1649926957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE IBE Provider 484-542-2985 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-02-25 |