| NPI | 1932312212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL M DEFAZIO Owner 262-654-0487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2011-08-11 |