| NPI | 1154911162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN WALTON Owner 336-615-6738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 1041C0700X Social Worker, Clinical | |
| 207QA0000X Family Medicine, Adolescent Medicine | |
| 207QA0505X Family Medicine, Adult Medicine | |
| 251S00000X | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QH0100X Clinic/Center, Health Services | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2021-01-23 |
| Last Update Date | 2021-01-23 |