| NPI | 1235237199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON DAVID VANDERSCOFF Managing Director 952-448-6557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2008-11-25 |