| NPI | 1053008748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILDEPHONSE FAYIDA Director 802-579-8027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2023-04-25 |