| NPI | 1841816006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIARA TOTTEN Owner 984-328-2321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-06-23 |