| NPI | 1275015661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE ROSE BURNS Executive Director 815-341-4378 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 6284-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16142132) |
| Enumeration Date | 2018-08-31 |
| Last Update Date | 2018-10-17 |