| NPI | 1366018129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN MCDONALD Credentialing Specialist 219-769-1670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2021-06-07 |