| NPI | 1295280345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD JERALD CROWDER Member/Manager 800-785-2316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 2141) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 575) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2016-08-18 |