| NPI | 1285181727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANE PERRY WALLACE Owner 682-232-4003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |