| NPI | 1194382945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE RANDOLPH JOHNSON Owner 336-639-7149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 261QH0100X Clinic/Center Health Service | |
| 261QP2300X Clinic/Center Primary Care | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 363LP2300X Nurse Practitioner Primary Care | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2023-10-31 |