| NPI | 1104073592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT EDWIN COLCLOUGH Director 251-625-0118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL lpc 111 al) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2008-09-16 |