| NPI | 1083320725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RASHAD QUINT'E RICHARDSON Director 336-740-1668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103K00000X Behavior Analyst | |
| 103TE1100X Psychologist Exercise & Sports | |
| 171400000X | |
| 174H00000X Health Educator | |
| 302R00000X Health Maintenance Organization | |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2023-01-27 |