| NPI | 1659006831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA RUDOLPH Owner 251-593-0319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2022-07-20 |