| NPI | 1760362248 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANEICIA GREEN Lcsw 984-837-0066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-09-04 |
| Last Update Date | 2025-09-04 |