| NPI | 1831064641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA DARVILLE Contract Administrator 855-932-7473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 1041C0700X Social Worker, Clinical | |
| 175T00000X Peer Specialist | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2025-10-09 |
| Last Update Date | 2025-10-10 |