| NPI | 1760279228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAEDORA MARYLOUISE BENTON Owner/CEO 678-499-7794 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2025-04-21 |
| Last Update Date | 2025-09-23 |