| NPI | 1467157115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA RANDALL Administrator 475-201-8549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-04-03 |