| NPI | 1306105382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB MICKEY Revenue Cycle Coordinator 419-693-0631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 3440) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2020-05-14 |