| NPI | 1306479712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA HENNESSY Co Owner 733-416-4459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-02-14 |
| Last Update Date | 2020-02-14 |