| NPI | 1932079035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAFIQUE KAKOOZA Authorized Official 800-689-6958 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Enumeration Date | 2025-11-05 |
| Last Update Date | 2025-11-05 |