| NPI | 1003302886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JO-ANN PRISCO VP Of Contracts 772-216-3031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2024-04-23 |