| NPI | 1528832839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELIZABETH FREDRICKSON Owner 210-722-7662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 207RA0401X Internal Medicine, Addiction Medicine | |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2023-11-09 |