| NPI | 1356858997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NADINE RENEE FISH Owner 269-359-1065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801090473) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2018-06-05 |