| NPI | 1245778166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA M WOODARD Office Manager 667-200-7175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA139) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: DC PRC11) |
| Enumeration Date | 2017-02-11 |
| Last Update Date | 2017-02-11 |