| NPI | 1225548860 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SPENCER KELLY BOWMAN CEO 276-524-1906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2017-10-10 |