| NPI | 1699300319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANNE JIVIDEN CEO 234-232-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2021-03-23 |