| NPI | 1750092896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA V JONES Provider 929-451-4290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 276400000X Rehabilitation, Substance Use Disorder Unit | |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2022-12-09 |