| NPI | 1154946259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSIDY DONOVAN Billing Specialist 877-535-9923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2020-06-15 |