| NPI | 1952698706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE FRANCES STACEY Owener 269-277-0025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2011-06-30 |