| NPI | 1043234628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN MATAVKA Vice President 262-641-9050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2013-02-19 |