| NPI | 1265069355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVANNE BREE JACKSON Sud Counselor Ii 909-624-1233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2020-03-27 |