| NPI | 1952062572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA NICHOLS Owner 606-359-3114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2022-09-06 |