| NPI | 1861952673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR REID Executive Director 866-586-2393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2019-03-20 |