| NPI | 1710465091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDOLPH DIXON Provider 908-280-5804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00268800) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2018-07-30 |