| NPI | 1033967518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY COLWELL Billing/Credentialing 910-524-8627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-05-09 |
| Last Update Date | 2024-09-30 |