| NPI | 1104978436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA BOMBARD Executive Director 815-232-6121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2020-08-22 |