| NPI | 1770919946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICARDO JOSE FORTENBERRY Chief Executive Officer 510-919-1302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 01-005785) |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2013-09-19 |