| NPI | 1881129880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KINYEL L DEPASS Owner 704-920-9561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL MH 12438) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2017-04-27 |