| NPI | 1487419180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NASIRA SHAADIYAH MAH-JABEEN Credentialing Agent 502-579-0170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-10-07 |