| NPI | 1982179180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR RILEY Accounts Manager 267-909-8264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2018-10-04 |