| NPI | 1740659697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA MASSO Sole Owner 304-541-9820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2015-09-22 |