| NPI | 1649695446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER NINEMIRE Director 315-295-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 6503) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 344) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2014-03-03 |