| NPI | 1851109045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE MARIE GVAZDINSKAS Clinical Director 217-416-9319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2024-12-20 |
| Last Update Date | 2025-04-22 |