| NPI | 1962077842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONYESHA FAGAN Owner 419-214-9302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2021-05-24 |