| NPI | 1720334949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE KERSHNER Owner 740-393-6001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E 0500681) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 081270) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2014-04-30 |