| NPI | 1174119622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY KENNETH DANIELS Counselor 252-776-3593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2020-12-18 |