| NPI | 1003088451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TALESHA ROLLOCK Provider Enrollment Specialist 919-256-0824 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2008-12-17 |