| NPI | 1750966982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER FACKELMAN Cco 419-724-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2022-11-15 |