| NPI | 1093215972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLETTE LASHONDA CARRINGTON Office Administrator 336-323-0066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2018-02-16 |