| NPI | 1972041929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA L COVELL Counselor 315-478-0610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 29935) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2017-02-09 |