| NPI | 1952964140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHEL FREDRICKSON CEO 870-632-5000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-08-06 |