| NPI | 1164957346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENYONA LANE Therapist/ Owner 704-577-4576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904009514) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2017-04-26 |