| NPI | 1164681979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMMI LYKINS WYNN Account Representative 336-768-5348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 635) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2008-06-06 |