| NPI | 1053964551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONSTANCE B POLITE Owner 336-816-0343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2019-07-23 |