| NPI | 1811745813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLAMIDE KOLAWOLE Owner/Provider 469-432-7154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2024-05-07 |