| NPI | 1174897391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY N USSERY Owner 704-300-5544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 347C00000X Private Vehicle |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 171M00000X Case Manager/Care Coordinator | |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 291U00000X Clinical Medical Laboratory | |
| 311Z00000X Custodial Care Facility | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 251S00000X Community/Behavioral Health | |
| 207R00000X Internal Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2025-11-20 |