| NPI | 1164770038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYLON WHITLEY Owner 919-649-4757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 1627) |
| Enumeration Date | 2012-08-26 |
| Last Update Date | 2012-08-26 |