| NPI | 1811688690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA ASHWORTH Credentialing Specialist 304-429-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2023-05-15 |