| NPI | 1265144331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER LYNN ROSEN Owner 304-790-7467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-12-20 |
| Last Update Date | 2022-12-20 |