| NPI | 1124333752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAMEQUA CHERIE PORTER Director 704-648-8972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2011-04-12 |