| NPI | 1922978675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE VISNICK COO 866-472-9466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261Q00000X Clinic/Center | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2025-11-07 |
| Last Update Date | 2025-11-07 |