| NPI | 1578014429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER DENECE WILSON Executive Director 844-562-2777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2016-10-16 |
| Last Update Date | 2019-01-03 |