| NPI | 1902933898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE VISNICK Business Director 866-472-9466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: PA 433860) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA 433860) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: PA 433860) | |
| 261Q00000X Clinic/Center (Licence: PA 433860) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: PA 433860) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: PA 433860) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2020-10-22 |