| NPI | 1124581392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN T KEATON President 336-508-0714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2019-04-12 |