| NPI | 1225549314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE BOSTICK-FAIRLEY Owner 910-361-4522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C010965) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-22162) |
| 251S00000X | |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2019-09-06 |