| NPI | 1790237592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR OKORIE Chief Executive Officer 602-441-2388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: AZ CSLG7866) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AZ LISAC-15037) |
| 101YP2500X Counselor Professional (Licence: AZ CSLG7866) | |
| 103TC0700X Psychologist Clinical (Licence: AZ 4010) | |
| 103TC1900X Psychologist Counseling (Licence: AZ 4605) | |
| 1041C0700X Social Worker Clinical (Licence: AZ LCSW-10962) | |
| 251B00000X Case Management (Licence: AZ CSLG7866) | |
| 261QM0850X Clinic/Center Adult Mental Health (Licence: AZ CSLG7866) | |
| 261QR0400X Clinic/Center Rehabilitation (Licence: AZ CSLG7866) | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2016-10-27 |