| NPI | 1114574217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KUMARA ELIAS HAMPTON Owner 505-903-8617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2019-08-22 |