| NPI | 1164763181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY MICHAEL WALLIS Owner 561-894-6010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2013-03-15 |