| NPI | 1225422686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY KORNEGAY Owner 252-412-3207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C009346) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-2786) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2015-03-24 |