| NPI | 1992466395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVONNE L DAVIS Npp 315-427-8540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-01-07 |
| Last Update Date | 2022-01-07 |