| NPI | 1194259598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CALVIN JAMES BRACE Agency Director 608-335-8093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 5884) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16072) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2017-04-12 |