| NPI | 1104562123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTY PHILLIPS Billing Manager 907-203-8600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2022-05-11 |