| NPI | 1124475264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DYLAN JAY FOSTER Counselor 231-920-8749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6401015391) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2016-05-18 |