| NPI | 1013261957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMEKO MICHELLE MOORE Presidente 336-887-0708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2015-03-25 |