| NPI | 1669853081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAHLIA DANNETTA DISTIN Owner 501-758-9993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2025-09-30 |