| NPI | 1356917298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE RAE ROTH Owner 605-610-5567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2023-09-06 |