| NPI | 1720848419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMEELAH JOHNSON Manager 571-320-0150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| 273R00000X Psychiatric Unit | |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2024-03-29 |