| NPI | 1750105896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AZAT KAREN JONES Owner 772-559-0182 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-11-14 |
| Last Update Date | 2025-05-02 |