| NPI | 1801485438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA SIMON Owner 198-950-1535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-01-18 |
| Last Update Date | 2021-01-18 |