| NPI | 1669250296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA WAGONER Owner 937-546-1083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2023-09-15 |