| NPI | 1932911989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTINA STICH Owner 612-203-1317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2025-01-24 |
| Last Update Date | 2025-06-13 |