| NPI | 1962709279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN RICHARD WHITE Clinical Social Worker 505-414-7479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NM I-07579) |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2011-02-22 |