| NPI | 1912122250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LEE SHELTON Program Manager 209-762-3014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 390017an) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2022-09-01 |