| NPI | 1750158556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HIETHAM ZEMAM Director 571-477-7725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2023-12-11 |