| NPI | 1730911876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILIE KATHERINE CLARK Owner 929-399-6755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-08-16 |
| Last Update Date | 2024-08-16 |