| NPI | 1407740582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALCOLM LEE BROADNAX Owner 443-528-0822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-06-04 |
| Last Update Date | 2025-09-04 |