| NPI | 1972354504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANDERSON President 855-380-6136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 103K00000X Behavior Analyst | |
| 1041C0700X Social Worker, Clinical | |
| 133NN1002X Nutritionist, Nutrition, Education | |
| 133V00000X Dietitian, Registered | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-08-06 |