| NPI | 1730355959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE ANN ODOM President Shared Services 947-522-3326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MI 6801068931) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2021-10-21 |