| NPI | 1205439569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN FRAZERJOHN Administrator 651-734-9633 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2020-11-19 |