| NPI | 1891074704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK E STORTVEDT Executive Director 4023-792-0301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2018-06-20 |