| NPI | 1083338032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY RENVILLE Licensed Clinical Mental Health Cou 704-899-1555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2025-04-15 |