| NPI | 1023580529 |
|---|---|
| Former Legal Business Name | NA |
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | COTIE LAWRENCE Owner 919-999-8241 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2018-12-20 |