| NPI | 1154967214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISETTE DE LEON Office Manager 703-743-4060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2022-04-12 |