| NPI | 1255877296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN TRAVIS THACKER Owner 336-575-5948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 9455) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 20293) |
| 225C00000X Rehabilitation Counselor (Licence: NC 00115237) | |
| Enumeration Date | 2017-01-14 |
| Last Update Date | 2017-01-14 |