| NPI | 1750195749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AZARIA ZHANE DAVIS Owner 631-965-9493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-02-03 |
| Last Update Date | 2025-03-02 |