| NPI | 1306902515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS JAMES RUNDQUIST Administrative Director 231-796-4637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401000066) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 540022) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2015-11-17 |