| NPI | 1093564148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONTRAVON HERBIN CEO 336-491-9006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 261QC1500X Clinic/Center, Community Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2024-05-13 |