| NPI | 1487900965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENNA A. KOEDAM Substance Abuse Services Supervisor 800-242-5101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 05041) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 001530) |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2012-08-02 |