| NPI | 1215022926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA S MITCHELL Credentialing Manger 984-900-6814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 0689010) |
| 103T00000X Psychologist (Licence: NC 0689010) | |
| 103TC0700X Psychologist, Clinical (Licence: NC 0689010) | |
| 103TF0000X Psychologist, Family (Licence: NC 0689010) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 0689010) | |
| 208000000X Pediatrics | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 0689010) | |
| 251S00000X Community/Behavioral Health | |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| 261QP2300X Clinic/Center, Primary Care | |
| 363A00000X Physician Assistant | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 0689010) | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2026-08-18 |