| NPI | 1891035572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY LYNN STAPLES Owner 860-874-2484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: FL SW10378) |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2023-02-07 |