| NPI | 1811304967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA THOMPSON Clinical Op Licensing Credentialing 844-291-4535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2016-06-23 |