| NPI | 1174922348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN K STOUDMIRE President/Owner 704-237-4240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NC 200500827) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2021-09-24 |