| NPI | 1295228120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE DIERCKS Owner 608-630-2484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2025-04-01 |