| NPI | 1093157240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLISSIEE PETERSON Owner Operator 336-437-4382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC MHL001230) |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2018-05-21 |