| 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 |