| NPI | 1104179555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMEKO MICHELLE MOORE President 336-887-0708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 251S00000X | |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2015-03-25 |