| NPI | 1730740309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRANCE PAGE Member 931-561-5252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2023-05-03 |