| NPI | 1235401811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVERY B. GREEN CEO 336-763-7287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 104100000X Social Worker | |
| 101YS0200X Counselor School | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| 1041S0200X Social Worker School | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2015-12-16 |