| NPI | 1255047445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELAWRENCE GRANT CEO 424-292-3726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-01-30 |