| NPI | 1013286236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON A TOWNSEND Billing Manager 910-920-0007 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0015X Psychiatry & Neurology Psychosomatic Medicine |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| 103T00000X Psychologist | |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2011-12-16 |
| Last Update Date | 2011-12-16 |