| NPI | 1285458836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON MARIE CRELLIN Owner 325-201-6817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-11-11 |
| Last Update Date | 2024-11-11 |