| NPI | 1073239653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON DOTSON Owner 862-334-4471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2022-11-17 |