| NPI | 1023775509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL LATHAM Manager 937-544-4020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-11-19 |
| Last Update Date | 2021-11-19 |