| NPI | 1215078209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE S OLDHAM Owner 262-894-1477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 14427) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 2398-123) |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2020-08-22 |