| NPI | 1336779461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA MAILLOUX JENSEN Owner 985-718-4507 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2020-01-16 |