| NPI | 1730692252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHALIE R GILLES Manager 239-270-9745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2017-11-06 |