| NPI | 1215715461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LEISTIKOW Practice Owner, Therapist 919-391-0122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2024-09-05 |