| NPI | 1760116297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDITH PATRICIA WATTA Owner 571-449-7837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2024-07-17 |