| NPI | 1407593619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE WAACK Co Owner 920-288-2846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2022-11-13 |