| NPI | 1679447106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVEN GARRITY Managing Director 980-925-0852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-09-29 |
| Last Update Date | 2025-09-29 |