| NPI | 1033421797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWIGHT HOWARD LYSNE Director 910-803-1620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 200301378) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NC 200301378) |
| Enumeration Date | 2010-07-11 |
| Last Update Date | 2010-07-11 |