| NPI | 1801594999 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASMINE TASHAE OWENS Lpc 346-379-2739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2023-12-12 |