| NPI | 1265959100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARQUITA RUSSELL Operations 980-258-9315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 1041C0700X Social Worker, Clinical | |
| 106S00000X Behavior Technician | |
| 175T00000X Peer Specialist | |
| 252Y00000X Early Intervention Provider Agency | |
| 253Z00000X In Home Supportive Care | |
| 374U00000X Home Health Aide | |
| 385H00000X Respite Care | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child | |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2023-08-15 |