| NPI | 1710626155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZEBULON FOREMAN Owner 678-401-6856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2023-02-18 |