| NPI | 1033991906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RASHAUNDA LAKEI PETTIFORD Owner 336-417-4164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 251S00000X Community/Behavioral Health | |
| 261Q00000X Clinic/Center | |
| 261QC1500X Clinic/Center Community Health | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QM2800X Clinic/Center Methadone | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2023-11-09 |