| NPI | 1235543802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYANN MACK RIKARD Administrator 336-772-2491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2014-06-11 |