| NPI | 1992575880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDRA KAYLA SHEPPARD Clinician 339-206-7477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2024-01-03 |
| Last Update Date | 2024-01-03 |