| NPI | 1245502798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA ANNETTE FULLER Owner/ Executive Director 704-236-1377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XM0800X Occupational Therapist Mental Health |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 106H00000X Marriage & Family Therapist | |
| 106H00000X Marriage & Family Therapist | |
| 171M00000X Case Manager/Care Coordinator | |
| 302R00000X Health Maintenance Organization | |
| 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-01-30 |