| NPI | 1558979146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA J CORREIA Manager 351-222-2698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2020-07-20 |