| NPI | 1316424526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PETERSON Billing Specialist 520-441-4754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LCSW13751) |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2018-07-20 |