| NPI | 1255542106 |
|---|---|
| Doing Business As | LCSNW |
| Entity Type | Organization |
| Authorized Contact | SHELIA CLARK Credentialing 541-201-3973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2023-02-13 |