| NPI | 1154928851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY MICHAEL WISE Member 704-706-5526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2020-10-06 |