| NPI | 1043075039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDALL MAURER Credentialing 980-434-8649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2025-04-08 |