| NPI | 1154861086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWIGHT HOWARD LYSNE Director 910-399-3927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK 118712) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: AK 118712) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: AK 118712) | |
| Enumeration Date | 2017-02-25 |
| Last Update Date | 2017-03-14 |