| NPI | 1578041463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC BACON CEO 651-703-3336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302461) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator | |
| 171W00000X Contractor | |
| 175T00000X Peer Specialist | |
| 405300000X Prevention Professional | |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-08-01 |