| NPI | 1912728650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRIEA THOMPSON Owner/Provider 937-369-1841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor Mental Health | |
| 133VN1201X Dietitian, Registered Nutrition, Obesity and Weight Management | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 363L00000X Nurse Practitioner | |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2024-10-23 |
| Last Update Date | 2024-10-23 |