NPI | 1053160713 |
---|---|
Entity Type | Organization |
Authorized Contact | RURIC (ANDY) CLESBY ANDERSON Md 483-361-7898 |
Organization Subpart ? | No |
Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
Enumeration Date | 2024-05-15 |
Last Update Date | 2024-05-15 |