| NPI | 1114894821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORDIE M LICCIARDI Manager/ Credential Specialist 701-580-4091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2025-10-20 |
| Last Update Date | 2025-10-20 |