| NPI | 1104202415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FELICIA S VAN RADER Administrator 617-799-6915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2021-07-12 |