| NPI | 1386097368 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW W CARLSON CEO 269-720-0071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 12306) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 621) |
| 101YP2500X Counselor, Professional (Licence: CO 11818) | |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2018-08-23 |