| NPI | 1023460821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY M PORTNER Managing Owner 954-895-6263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 1706AD859301) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2016-07-06 |