| NPI | 1043086713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNICO ANDREW MAGANA Clinical Service Technician 209-247-0735 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-12-04 |
| Last Update Date | 2023-12-04 |