| NPI | 1205172335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATSY PACE Administrator 870-293-4478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: AR 2016009) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 0256l) |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2017-01-06 |