| NPI | 1063547990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA VAN DE BOVENKAMP Medical Office Administrator 910-790-9949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |