| NPI | 1679331284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA MCBROOM Director 731-215-0449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-03-08 |
| Last Update Date | 2024-03-08 |