| NPI | 1568809366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAITH CLARK Counselor & Therapist 218-830-8085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2022-01-31 |