| NPI | 1114682549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLEY L BENTON Owner 919-234-7247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 133V00000X Dietitian, Registered | |
| 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics | |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2021-11-01 |