| NPI | 1245091925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA MAYNARD Provider 910-616-9197 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-01-19 |