| NPI | 1164767356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK BRADLEY FORTUNE Counselor 818-694-7206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2012-11-29 |