| NPI | 1508249939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORGE PENA Director 319-202-1509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 1370) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2015-07-06 |