| NPI | 1972702520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES K ROBERTS Authorized Official 888-830-0347 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| 171M00000X Case Manager/Care Coordinator | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2024-08-06 |