| NPI | 1073652947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAQUTA LASHALL COURMAN Qualified Professional 252-638-4555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC 322D00000X) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-11-07 |