| NPI | 1891495636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA WILKINSON Provider 833-378-2552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 101Y00000X Counselor |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2023-03-09 |