| NPI | 1164735254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWIGHT HOWARD LYSNE Director 910-803-1620 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: NC 200301378) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2010-07-19 |