| NPI | 1770049769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY MICHELLE JENKINS Owner 207-837-6599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2023-11-05 |