| NPI | 1760211304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNDRE LEYDON Owner 772-353-2485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2024-07-31 |
| Last Update Date | 2025-10-31 |