| NPI | 1831858190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA ROGERS Owner 667-500-4556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2023-03-01 |