| NPI | 1962860635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WANDA THOMPSON Clinical Op Licensing Credentialing 844-291-4535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2016-02-18 |