| NPI | 1699543777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERROLYNN JUSTUSSON President 800-743-0396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2023-12-18 |