| NPI | 1154923316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN MINGIA Director 910-970-4673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-11-12 |
| Last Update Date | 2023-06-02 |