| NPI | 1003432121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY CLARK Practice Administrator 919-785-5055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2023-02-23 |