| NPI | 1114268844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEATRICE ELLISON Sole Proprietor 910-944-0938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC 5580) |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2025-09-23 |