| NPI | 1467208389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATINA RUSSELL Credentialing Specialist 312-663-1130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-06-14 |