| NPI | 1053398586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LEWIS Executive Director 336-274-5909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2019-03-11 |