| NPI | 1750092896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA JONES Provider 929-451-4290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 276400000X Rehabilitation, Substance Use Disorder Unit | |
| 1041C0700X Social Worker Clinical | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2025-02-12 |