| NPI | 1902773005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON THOMPKINS Owner 765-573-5218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2025-10-22 |
| Last Update Date | 2025-10-22 |