| NPI | 1790547313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE DIANE LILLY Owner 304-731-5195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2024-01-29 |