| NPI | 1205243268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE TYSON Director 980-213-5501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QH0100X Clinic/Center, Health Services | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2014-07-22 |