NPI | 1245414184 |
---|---|
Entity Type | Organization |
Authorized Contact | DEREK BULLARD CEO 704-521-4977 |
Organization Subpart ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
Additional Taxonomies | 103T00000X Psychologist |
103TP2701X Psychologist, Group Psychotherapy | |
2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
Enumeration Date | 2007-12-27 |
Last Update Date | 2007-12-27 |