| NPI | 1780060723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARISSE CARUTH Clinical Instructor 984-974-4861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2015-07-31 |