| NPI | 1730818048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENARD FENAUD CEO 772-408-3907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 251B00000X Case Management |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2024-05-30 |