| NPI | 1700546561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE WATKINS Owner 662-207-4610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2021-12-21 |