| NPI | 1093880213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TALESHA ROLLOCK Provider Enrollment Specialist 919-256-0824 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 106H00000X Marriage & Family Therapist | |
| 103T00000X Psychologist | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2009-04-24 |