| NPI | 1194397596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICICA CHAMBERS Owner 704-493-3356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |