| NPI | 1770250300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABIGAIL W LAVOO Manager/Administrator 719-600-3011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2021-08-30 |