| NPI | 1831912716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNA HICKEY Clinical Social Worker 857-400-0868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-11-07 |
| Last Update Date | 2024-11-07 |