| NPI | 1174122170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER MARSHALL Director 531-876-7455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 251C00000X | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2021-07-02 |