| NPI | 1699035949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER FUTRELL Credentialing Specialist 740-788-0239 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-05-21 |