| NPI | 1740731256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENAY ANTOINETTE BLOOM Chemical Dependency Professional 509-469-9366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00003747) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-10-19 |