| NPI | 1992585962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD ROY SPENCER Owner/Operator 334-233-7361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-10-05 |