| NPI | 1720827512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN MARIE RUSSELL Owner 330-840-9385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2024-08-14 |