| NPI | 1790556157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY COOK Owner 571-473-5384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2024-01-12 |