| NPI | 1053841130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN LYNCH Owner 331-205-5998 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2017-06-12 |