| NPI | 1396611968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON MICHAEL GRAY Owner 475-364-5035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2025-10-13 |