| NPI | 1043078991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY KECK Owner, Provider 153-177-2974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2024-03-06 |
| Last Update Date | 2024-03-06 |