Organization
SELF-AWARENESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEROME MILLER B.S., CADC (EXECUTIVE DIRECTOR)
(515) 277-0320
Entity
Organization
Contact information
Practice address
2301 FOREST AVE, DES MOINES, IA 50311-3113
(515) 277-0320
Mailing address
2301 FOREST AVE, DES MOINES, IA 50311-3113
(515) 277-0320
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14007
IA
Other
Enumeration date
01/16/2015
Last updated
01/16/2015
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