| NPI | 1457896896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMMA C WANG Owner 574-252-7233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: IN BX2361145) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2020-09-01 |