NPI | 1407998719 |
---|---|
Entity Type | Organization |
Authorized Contact | JACQUELINE V MCRAE President 262-637-9984 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
101YM0800X Counselor, Mental Health | |
261QM1300X Clinic/Center, Multi-Specialty | |
Enumeration Date | 2007-02-13 |
Last Update Date | 2021-08-06 |