| NPI | 1003961269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TALESHA ROLLOCK Provider Enrollment Specialist 919-256-0824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2009-04-23 |