| NPI | 1720470362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE R MCWADE Owner 563-275-6728 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 001626) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 13040) |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2015-09-23 |