| NPI | 1861153231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AQUANATTE MONIQUE JACKSON Director 725-696-9982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2022-09-14 |