| NPI | 1487242152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE CHARLES Consultant 323-485-6842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2021-01-07 |