| NPI | 1700698164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAM NANTANG Owner 743-222-9755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2025-01-23 |
| Last Update Date | 2025-01-23 |