| NPI | 1063279578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE AMBER WATTS GOGG Owner 704-530-8341 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2024-03-01 |
| Last Update Date | 2024-07-17 |