| NPI | 1194124933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY LOUISE CHARLES Clinical Director 866-736-6408 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC C008679) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2024-10-28 |