| NPI | 1851786529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE LANDERS Owner 262-408-0588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 6864123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 6864123) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2020-05-16 |