| NPI | 1184040131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALENA E WIEMAN Program Director 719-232-7981 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: CO 1741-01) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2014-04-23 |