| NPI | 1134966989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL BANGURA Administrator 623-216-5759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 251B00000X Case Management | |
| Enumeration Date | 2024-07-10 |
| Last Update Date | 2024-07-28 |