| NPI | 1093308405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIGH ANN HARVEY Program Manager 681-207-7105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 171M00000X Case Manager/Care Coordinator | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2023-01-30 |