| NPI | 1205482460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY C JOHNSON Member 919-437-6627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2019-08-14 |