| NPI | 1831883925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA ELAGINA Member 872-760-4353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2023-11-05 |