| NPI | 1467347278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVIS STEPHEN Cco 479-422-1581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2025-06-11 |
| Last Update Date | 2025-10-07 |