| NPI | 1780219857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY SMITH Clinical Director 304-550-6849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2023-04-18 |