| NPI | 1447621768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY LAUREN ROSS Business Manager 202-695-9856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2016-03-08 |