| NPI | 1124609987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REVA MINGO Licensed Professional Counselor 959-245-4516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 276400000X Rehabilitation, Substance Use Disorder Unit |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2022-05-18 |