| NPI | 1205515566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAUDETTE GREEN Chef Executive Officer/Owner 704-909-0304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2025-07-25 |