| NPI | 1891544375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATONYA HOLLAND Owner 737-326-5315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-05-16 |
| Last Update Date | 2024-05-16 |