| NPI | 1083257562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN A JACKSON Senior Administrator 910-247-6822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2019-10-28 |