| NPI | 1891591012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROMEY GLIDEWELL Division Administrator 085-878-3375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 2083A0300X Preventive Medicine, Addiction Medicine | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2025-02-19 |
| Last Update Date | 2025-02-19 |