| NPI | 1942576236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON LEE ANDERSON Addictions Counselor 618-877-4420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2012-03-30 |