| NPI | 1184204950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDEN FASKEN Chief Operating Officer 815-780-0690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 104100000X Social Worker | |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2024-04-19 |