| NPI | 1962293431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIESHA CARVIL Owner 754-303-9976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-05-14 |
| Last Update Date | 2025-05-14 |