| NPI | 1033204300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA FULLER JOHNSON Director/Qualified Professional 252-363-5446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL098100) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |