| NPI | 1174764716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MARK GISHKIN Chief Executive Officer 602-708-4719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-0079) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-0181) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2009-03-11 |