| NPI | 1659149565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK JOHNDON President 708-657-5043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-12-20 |
| Last Update Date | 2023-12-20 |