| 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 |