| NPI | 1396101200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUTUMN KAYLEN MIZE Director Of Outpatient Operations 984-200-2780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2026-02-05 |