| NPI | 1013460211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLIS RAY BUTLER Therapist 980-319-4357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC 1462109) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2016-07-25 |