| NPI | 1750881066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA E T BENNETT Sole Proprietor 270-315-1443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2018-02-14 |