| NPI | 1174195630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE CHRISTINE JOHNSON Co Owner, Psychologist 336-257-1332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |