| NPI | 1053498683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMETRIOUS SHEPARD CEO Clinical Director 910-347-1694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2012-07-20 |