| NPI | 1780935676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WISLINE FRANCOIS Theraputic Mentor 857-350-6688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MA S11923671) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2012-10-02 |