| NPI | 1659926681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHONDELL GANTZER Office Manager 701-720-2964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2020-02-05 |