| NPI | 1528691524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARUE MCNISH Owner 860-478-1175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-02-18 |