| NPI | 1225297633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LETISHAL JUANITE KELLY Owner 704-493-0466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2023-12-07 |