| NPI | 1164708228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON KERSEY Sole Proprietor 704-323-6586 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 2531) |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2011-11-02 |