| NPI | 1730553108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA KOVALL Vice President Of Managed Care 833-510-4357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: AZ 4476) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: AZ 4476) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 4476) | |
| 261Q00000X Clinic/Center | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2015-11-21 |
| Last Update Date | 2022-12-29 |