| NPI | 1225049760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI LYNN MOSS Credentialing Specialist 810-294-4880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 740040) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2024-02-06 |