| NPI | 1114124401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY M GODIN Owner 910-270-9995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 2335) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 4801) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 2335) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2012-07-31 |