| NPI | 1740885102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA LACY MCCLINTOCK Licensed Clinical Social Worker 251-233-0929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2020-12-03 |
| Last Update Date | 2020-12-03 |