| NPI | 1194050435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI TILLEY PROVINCE Organizer/Member 336-818-0733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 5534) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2024-08-13 |