| NPI | 1215656137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA WARNER Administrator 985-276-4165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 2084A0401X Psychiatry & Neurology Addiction Medicine | |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2024-01-18 |