| NPI | 1811536253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYJIONE KING Owner 870-882-8345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2020-02-23 |