| NPI | 1245926070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA MONIQUE FULLER Pmhnp 336-459-9565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2024-04-03 |