| NPI | 1912119835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE IVAR HANNIBAL LLC Manager 503-254-1545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 01-11-26) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L0525) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |