| NPI | 1699233270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA GROSS Owner 920-809-6766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2019-03-04 |