| NPI | 1962293431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIESHA CARVIL Owner 754-303-9976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X Community/Behavioral Health | |
| 261QC1500X Clinic/Center, Community Health | |
| 261QH0100X Clinic/Center, Health Services | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 305R00000X Preferred Provider Organization | |
| Enumeration Date | 2025-05-14 |
| Last Update Date | 2026-07-15 |