| NPI | 1962913418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER CHAVIS Office Manager 251-421-5255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: AL 1-053065) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-053065) |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2017-10-23 |