| NPI | 1174181697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLIN BEATTY CEO 339-368-7696 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 261QM0801X | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2019-05-30 |