| NPI | 1205023884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA DEVON WILSON Program Manager 919-872-1178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 103TC0700X Psychologist Clinical | |
| 103TC1900X Psychologist Counseling | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0000X Psychologist Family | |
| 103TH0100X Psychologist Health Service | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2007-10-27 |