| NPI | 1972086593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL GABRIELLE FULLER Owner 856-979-6733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2023-05-01 |