| NPI | 1255808036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE BUSH Clinical Director 704-879-1179 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101Y00000X Counselor |
| 251S00000X Community/Behavioral Health | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2026-03-04 |