NPI | 1871200907 |
---|---|
Entity Type | Organization |
Authorized Contact | EARNESTINE BURKE Managed Care Specialist 833-510-4357 |
Organization Subpart ? | No |
Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
207QA0401X Family Medicine, Addiction Medicine | |
Enumeration Date | 2022-10-28 |
Last Update Date | 2024-01-26 |