Organization
SOBER ICT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD L VAILLANCOURT JR. MA, LAC (DIRECTOR)
(316) 833-2739
Entity
Organization
Contact information
Practice address
200 W DOUGLAS AVE STE 360, WICHITA, KS 67202-3019
(316) 833-2739
Mailing address
200 W DOUGLAS AVE STE 360, WICHITA, KS 67202-3019
(316) 833-2739
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/04/2024
Last updated
11/04/2024
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