| NPI | 1962001321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMIKA T STEVENSON President 267-671-2311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1100X Clinic/Center, MilitaryU.S. Coast Guard Outpatient | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2020-10-17 |
| Last Update Date | 2020-10-17 |