| NPI | 1164809398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARIANNA DENEANNE FULTON Administrator/Owner 336-505-8655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2015-04-27 |