| NPI | 1497230429 |
|---|---|
| Doing Business As | ETHRIDGE |
| Entity Type | Organization |
| Authorized Contact | WILLARD RICHARD STROUD Counselor 619-231-6361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2018-09-25 |