| NPI | 1710717533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE COURTNEY Cco 877-968-2363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2024-08-06 |