| 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 |