| NPI | 1952002214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORRENDA SMITH Director 833-445-3711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2026-06-02 |