| NPI | 1760943062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL LEE SANTIAGO Owner 702-806-3226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2019-03-28 |