| NPI | 1699388744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIJUAN MALCOLM GRIMES License Mental Health Counselor 201-503-5642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 261QM0850X Clinic/Center Adult Mental Health | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-08-28 |