| NPI | 1780432575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARLA PETERSON Owner 229-310-5065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-05-08 |
| Last Update Date | 2024-06-25 |