| NPI | 1225318637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL W. HURSE Program Director 612-203-9809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 1044690-2CDT) |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2011-08-17 |