| NPI | 1336013986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA L WATERS Clinical Supervisor 531-242-8821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2025-10-06 |
| Last Update Date | 2025-10-06 |