| NPI | 1114490984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANESE D WILLIAMS Credentialing Specialist 910-860-7008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2019-04-08 |